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m o --I -a — cn <br /> Iwo <br /> Arn <br /> v f W000 (D <br /> 1l O J v <br /> c <br /> o ` <br /> � w <br /> � Ww <br /> Q <br /> ° c 3 c <br /> M N 7 6 <br /> _ CD G <br /> � w 4t <br /> i'ieasa P+"rrf or (Form tl Wr use an slim 12 ,rr1, x p v <br /> Cil <br /> UMIFORA lq,AWDM I p^�w Namara PnrxraO J i v N <br /> WASTE MAMIFEST - - <br /> 5�rxrarcrkNemxaMMalxngAdsmxx . - c.�„r,. .r„sn.aA.:"+er ar lwrr rrr+""eer"nr V O CT M <br /> ,r <br /> v <br /> t 4 - 00 <br /> Genprabh fiprrh"� •: `i � / z <br /> e Treppes"�r cnmw�v Nems U.5 f C 4~ O O CD <br /> N v CD <br /> r ra^wmrsraconaxnr wma, - u.6 EPA,o nrs60 J 0. <br /> O <br /> A OoagrraradF try Hams ann She Atl'drett <br /> hf+'.I•'! .�, rF^+ us.EPA to xfurrCer v <br /> N G <br /> oa 9b U.S.oo �c tion flndutlin (n <br /> w 9 RnPerSmppmg Name.aaurtf Class,rD Number, t0.Conreirrerx _ - Q 0 <br /> vrA arm Px4m9G1aWlifany3l tr rmw r?;p,,., <br /> r.asv:.rx. C <br /> C ryq rype 'a a�ctr •r f ,..f n <br /> O O O <br /> w � 00CO Cp CL D <br /> W O <br /> N ::p <br /> C— n <br /> r w � <br /> O <br /> 1x SPec;al Hantleng;nsrruceorrs and4ddrhonal inrennar�us � <br /> (D <br /> CL <br /> 15 GEMERAT ialis FFEROR'3 CfRT1FICATIOM:I hereby declare that the conlenCs oftnrs consignment are[uilyand acruramly descnl�ed above L the pre O CDD <br /> marked antl ir*th I!the .I andare in ap respects;n proper Corditan for aansportavmrdin lo-a livable mtemasonal and national <br /> Exyaner.I unity that the contents of Ibis aonsignmenl wnfarm tithe terms o[thea g � y Per snipping name.and am � �. <br /> I Oar*that the waste minimiWWn stammem identified Wm 1'CFR the 18(aJ fidl"a a EPAAckw redgmem or Consent. govsmmenlal reguewns If expod shipmortt attl I am�!e'�raY Oo � <br /> Ge^e2rnlc10lleror;s Pnnte"Tvpsd Name quanLry generemr)or b if am a small uanti M <br /> (1 I q lygeneramd Is true <br /> Signature (b 7 <br /> n:5ma0onal-shrpmenis D" 1t M <br /> from U.5 <br /> L E <br /> Import Io U.S, `� I C— n <br /> hansponer signature(WrexpoRs amylExpo <br /> : ❑ rt <br /> Port <br /> � 17 TkansponerAclrnawledgmenl of Reoeiptof Materials t7ate le leavingving U s <br /> U.S.: -- — <br /> TnineearNOI Pnnlea7 Nam ----- <br /> O Yp¢d e <br /> aSignature N O <br /> 2 r1a1sr!oner2Pnn1ea7yped Nama Moro, 'bf rNkr N � <br /> Q <br /> ti Srgnamre !✓ w <br /> Month d7 C� <br /> 18 Discrepancy Dry 1"ar CO <br /> 19a Discrepancy indicason Space O (.fl <br /> r <br /> ❑Type _ w <br /> ❑R¢sidli¢ C111W 00 L <br /> LJ Panral Raje�in �cF'* L <br /> Ry"'h' 00 <br /> 1&b.AliemateF rmt:.r Manifest Refe <br /> rents Number. <br /> U .....—«..4-aU.S.EPA Ip Number <br /> +- Fa&q's Phone: N) <br /> N <br /> N) <br /> 18c S!pnature olAlremate Facllrry(ur Generalorl C— <br /> C Cb <br /> 3 19.Hazardous Waste Report Il7anage'n Method � O <br /> Codes{i.e_,codes Porhazard4us wastreatment.disposal,and roc <br /> � 2. te yding syslemsl � v <br /> 3. <br /> { <br /> 20.Designated Facility,6Aner or Operates.Cenificafran of <br /> receipt4f hazardous materials rovered by the manifest except as noted In Item tga O � <br /> Prrn[aCryped Name 0 <br /> CP � <br /> Signatue (b C— O- <br /> (L) L Q <br /> jrmg70n-:-1rRe. are obsolete <br /> w T <br /> GEN N �D <br /> C-- CO w� - o <br /> Cil <br /> _. co � <br /> 0 0 <br /> CO w <br />